Universal CMS PCN for Medicare Part B Billing
Pharmacies can now consolidate all Medicare Part B billing using a single BIN/PCN combination: BIN 025656 and PCN CMS. DocStation automatically determines the right submission destination based on the product billed — local Medicare carrier for most claims, DME MAC for applicable DME products — eliminating the need to manage individual PCNs for each Medicare Part B plan. The payer name and PCN are sent back in the BIN billing response so you can see exactly where the claim is headed.
Medicare Fee Schedule Integration
A new opt-in feature for the RelayHealth integration uses the Medicare Fee Schedule to calculate paid amounts on BIN billed claims based on allowable amounts for mapped HCPCS codes. To enable it, navigate to Organization Settings → Locations → Data Exchange → RelayHealth integration card and toggle on the Medicare Fee Schedule option.
Self-Service Non-Vaccine Product Billing
The Dynamic BIN Billing NPI Allow List has been deprecated. Pharmacies now have direct control over whether to allow billing of non-vaccine medications through their own organization settings — no DocStation admin action required. You'll find the toggle in the RelayHealth integration card under your location's Data Exchange settings.
Real-Time Medical Claim Creation
Medical claims created from BIN billing are now visible in DocStation immediately after submission — no delay, no waiting for a background sync. Reversals, modifications, and resubmissions also reflect in real time, giving you complete visibility into the claim as soon as it's created.
Real-Time Reversal Auto-Cancel
When a BIN-billed claim is reversed, DocStation now automatically cancels the corresponding medical claim in real time. This keeps your claims queue clean without requiring manual intervention when a reversal comes through.
BIN Billing Claim Validations
A new set of claim validations shipped to improve first-pass acceptance rates on BIN-billed claims. These validations run before submission and surface issues early, with the ability to override each one using specific DUR codes when needed. The rejection message on the claim will include the appropriate override codes.
New validations:
- Refill too soon — alerts when a refill is attempted before the appropriate time window
- Prior authorization required — activates for CPT codes with the Require Prior Authorization variant
- Diagnosis code required — applies to NDC-to-CPT mappings that don't include a CVX code
- Medicare Part B rejection for specific CPTs — rejects claims billed to Medicare Part B for CPT codes designated with the Reject Medicare Part B variant, such as vaccines not typically covered under Part B
Claims Table Filter Updates
A handful of useful filter and column improvements shipped in July:
- Reversed Date is now available as both a column and a filter on the claims table
- Submitted Date and Payer Received Date now more accurately reflect expected dates
- Diagnosis filters with "starts with" and "ends with" options now work correctly, including the ability to filter by Z diagnoses
Dataset Updates
Two dataset improvements shipped in August:
- Improved dataset organization makes finding the right dataset easier when configuring automations and billing rules
- New CPT Variant for identifying CPT codes that should be excluded from claim deduplication logic
Individual Rule Evaluation Replay
Automation rule evaluations can now be replayed individually for filtered, stopped, or failed evaluations, giving more granular control when troubleshooting automation rules. Reach out to DocStation Support if you need a hand with this.
Eligibility Check DUR Override
Users can now override the eligibility check step in BIN billing workflows using DUR code TP, R0, 1B. This is an alternative to the Intermediary Authorization override and can also help bypass EDI enrollment issues when you need claims created immediately.
Change Healthcare Claims Status Updates
Claims submitted through Change Healthcare in "Processing" status now receive automatic status updates to Paid or Denied via Claim Status Checks. The system runs checks approximately 30 days after submission, then every two weeks up to 90 days. The update source — status check vs. ERA — is visible in claim history.
Auto-Submit Time Window Configuration
Flexible auto-submit time windows are now available for Base and Enterprise subscriptions. Organizations can configure claims to auto-submit at 48 hours (default), 7 days, 14 days, or 28 days after claim creation. Essentials subscriptions retain access to the 48-hour window.
